Gebelik ve Emzirme Döneminde Psikofarmakolojik Yaklaşımlar
Özet
Perinatal dönemde görülen psikiyatrik bozukluklar ile bu süreçte uygulanan psikofarmakolojik yaklaşımlar, biyolojik ve sosyal riskler çerçevesinde ele alınmaktadır. En sık gözlenen gebelik depresyonu; erken doğum, düşük doğum ağırlığı ve gebelik diyabeti gibi riskleri tetiklerken, gelişmekte olan ülkelerde %50'ye varan oranlarda saptanan postpartum depresyonun tedavisinde brexalonone spesifik onay alan ilk moleküldür. Üreme çağında sıkça karşılaşılan şizofreni hastalarında planlanmamış gebelik oranları yüksektir ve postpartum psikoz ise suisid ile infatisid riskleri barındıran acil bir tablodur. Bipolar bozukluğun perinatal dönemde tetiklenmesinde hormonal ve immünolojik süreçlerin rol oynadığı düşünülmektedir. Psikotrop ilaç seçiminde monoterapi ve minimal etkin doz prensipleri benimsenmeli; lityum kullanımında Ebstein anomalisi, valproat kullanımında nöral tüp defektleri, otizm spektrum bozukluğu ve çocukta zeka seviyesinde düşüş riskleri göz önünde bulundurulmalıdır. Antidepresanlardan sertralin en güvenli seçeneklerden biri olarak öne çıkarken, paroksetin kalp anomalisi riskini artırmaktadır. Birinci kuşak antipsikotikler düşük doğum ağırlığı riski taşırken, ikinci kuşak antipsikotiklerin teratojenik etkiden ziyade obezite, diyabet gibi gestasyonel metabolik komplikasyonlara yol açtığı saptanmıştır.
Psychiatric disorders observed in the perinatal period and psychopharmacological approaches implemented within this process are evaluated within the framework of biological and social risks. Gestational depression, which is most frequently encountered, triggers risks such as preterm birth, low birth weight, and gestational diabetes, whereas brexalonone is the first molecule to receive specific approval for treating postpartum depression, which is detected at rates up to 50% in developing countries. Unplanned pregnancy rates are high among schizophrenia patients frequently encountered during childbearing age, and postpartum psychosis represents an emergency picture harboring suicide and infanticide risks. Hormonal and immunological processes are thought to play a role in triggering bipolar disorder during the perinatal period. Monotherapy and minimal effective dose principles must be adopted in psychotropic drug selection; risks of Ebstein's anomaly in lithium use, and neural tube defects, autism spectrum disorder, and decline in the offspring's intelligence levels regarding valproate use must be considered. Among antidepressants, sertraline stands out as one of the safest options, whereas paroxetine increases the risk of cardiac malformations. While first-generation antipsychotics carry a risk of low birth weight, second-generation antipsychotics have been found to induce gestational metabolic complications such as obesity and diabetes rather than teratogenic effects.
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